• Section A (Minor's Personal Information):
  • Complete your personal information.
• Section B (Employment Information):
  • Bring the form to your employer to complete this section and to sign and date the Promise of Employment.
• Section C (Physician's Certification):
  • This section should be signed and stamped by your physician.
• Section D (Proof of Age):
  • Provide a copy of your birth certificate, passport or baptismal certificate to us to verify your birth date.
• Section A (Parent/Guardian Authorization):
  • Parent/Guardian must sign and date this section.
• Section F (Signature of Minor): 
  • You (the minor) must sign and date this section.
• Section E (School Record):
  • Bring the form to your high school to sign and date.
• Section F (Issuing Officer Certification):
  • Bring completed form to the Main Office at Shawnee High School for signature. Return the original form to your employer and we will submit a copy to the state of NJ.

Please note: You can electronically fill out the paperwork but you must print it out and sign it.  You cannot electronically sign this document; it will not be accepted.  You may also print it out and fill it out with pen.

For any questions please contact Jessica Clark in the main office - jclark@lsrhd.org or 609-654-7544, extension 445000